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epithelial Neoplasia Flashcards

1
Q

what is squamous papilloma and what causes it

A
  • benign, HPV induced proliferation of stratified squamous epithelium
  • HPV 6, 11
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2
Q

what are the clinical features of squamous papilloma

A
  • most common in adults
  • most common sites: soft palate, tongue, lips
  • soft, painless, exophytic nodule
  • numerous fingerlike surface projections- papillary appearance
  • white, red, normal in color
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3
Q

what is the tx for squamous papilloma and will it recurr

A
  • surgical excision
  • recurrence unlikely
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4
Q

what is verruca vulgaris

A
  • benign, HPV induced proliferation of stratified squamous epithelium
  • HPV 2
  • predominatly a skin lesion
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5
Q

what are the clinical features of verruca vulgaris

A
  • most common on skin of hands
  • rarely occurs intraorally
  • children and adults
  • painless papule or nodule with papillary projections
  • rough, pebbly surface
  • pink, white, yellow
  • may be multiple, clustered
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6
Q

what is the treatment for verruca vulgaris

A
  • skinL topical salicylic acid, lactic acid, liquid nitrogen cryotherapy
  • surgical excision for atypical cases
  • oral: surgical excision, laser ablation
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7
Q

what is the histo apperance of squamous papilloma

A

papillary epithelium

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8
Q

what is the histo of verruca vulgaris

A
  • papillary projections
  • all keratin
  • cup shaped proliferation
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9
Q

what is condyloma acuminatum

A
  • HPV induced proliferation of stratified squamous epithelium of the anogenital region, mouth and larynx
  • 90% cases- HPV 6 and 11 may have co-infection with high risk types
  • common STD
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10
Q

what are the clincial features and tx for condyloma acuminatum

A
  • dx in teens, adults
  • most common sites: labial mucosa, soft palate, lingual frenum
  • sessile, pink, exophytic mass
  • short, blunted surface projections
  • usually larger than papilloma greater than 1 cm
  • treatment: surgical excision, laser ablation
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11
Q

what is the histo apperance of condyloma acuminatum

A
  • papillary projections
  • more endophytic projections
  • koilocytes are the main feature
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12
Q

what is sebarrheic keratosis

A
  • benign proliferation of epidermal basal cells
  • common skin condition in elderly
  • positive correlation with sun exposure
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13
Q

what are the clinical features and tx for seborrheic keratosis

A
  • develops on the skin of face, trunk ,extremities
  • begin to develop in the 4th decade
  • sharply demarcated plaques
  • fissured, pitted, verrucous or smooth surface
  • stuck onto the skin
  • dermatosis papulosa nigra: variant of SK
  • tx: seldom removed, unless aesthetic purposes, may resemble melanoma
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14
Q

what is dermatosis papulosa nigra

A
  • a variant of SK
  • commonly observed in black individuals
  • multiple small (1-4mm) dark- brown to black papules on skin
  • scattered around the face, especially zygomatic, periorbital region
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15
Q

what is the histo of SK

A
  • proliferation of epidermis- basal epithelial cells
  • canthosis of epidermis
  • looks wide and thick
  • pseudocystic structures are most common characteristic
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16
Q

what is a melanocytic nevus

A
  • benign, local proliferation of nevus cells
  • may arise from surface epithelium or underlying connective tissue
  • very common
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17
Q

what are the clinical features and tx of melanocytic nevus

A
  • begin to develop during childhood, most earlier than 35 years
  • most common in white individuals
  • flat or elevated soft nodule
  • smooth surface
  • often mulitple
  • rare in oral cavity
  • tx: usually not indicated
  • if it changes in size may need biopsy
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18
Q

what is a tobacco pouch keratosis

A
  • smokeless tobacco: chewing tobacco, moist snuff, dry snuff
  • results from contact with caustic agents with tobacco
  • low malignant transformation potential
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19
Q

what are the clinical features and tx of tobacco pouch keratosis

A
  • grey/white fissured or wrinkled patch
  • diffuse, poorly defined margins
  • gingival recession
  • treatment: normal appearance 2-6 weeks after habit cessation
  • biopsy severe lesions
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20
Q

what is frictional keratosis

A
  • keratosis produced by trauma: teeth, ill fitting denturesw
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21
Q

what are the clinical features and tx of frictional keratosis

A
  • lower lip mucosa, lateral tongue, buccal mucosa
  • edentulous alveolar ridge- benign alveolar ridge keratosis (BARK)
  • diffuse white keratotic areas
  • tx: biopsy, no further tx because no malignant potential
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22
Q

describe nicotine stomatits

A
  • mucosal change of hard palate in response to heat in tobacco smoke
  • MC in pipe smoking
  • not premalignant
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23
Q

what are the clinical features and treatment of nicotine stomatitis

A
  • most common in older men over 45 years
  • numerous elevated papules with punctate red centers on palate
  • palatal mucosa- diffusely grey or white
  • tx: reversible, palate usually returns to normal 2 weeks after smoking cessation
  • encourage patient to stop smoking
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24
Q

what is leukoplakia

A
  • a white plaque of questionable risk having excluded known diseases or disorders that carry no increased risk for cancer
  • precancerous lesion
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25
what are the risk factors for leukoplakia
- tobacco smoking- 80% of patients with leukoplakia, heavy smokers, larger and more lesions, may regress with smoking cessation - alcohol- synergistic effect with tobacco smoking - UV light- luekoplakia on lip vermillion- actinic chelitis
26
what are the clinical features for leukoplakia
- middle age- eldery adults - male predilection - ventral tongue, FOM and soft palate are more likely to show dysplasia - well defined borders
27
what is dysplasia
abnormal cells that precede the development of cancer
28
what do early/thin leukoplakias look like
-flat, white/grey plaque, may be translucentw
29
what do homogenous/thick leukoplakias look like
leathery, fissured white plaque
30
what do non homogenous leukoplakias look like
nodular or verrucous areas - erythroleukoplakia: scattered patches of redness
31
what is proliferative verrucous leukoplakia
- multifocal disease - 4:1 female - mean age is 7th decade - more than 45% cases associated with tobacco - malignant transformation 70-100%
32
what are the clinical features of proliferative verrucous leukoplakia
- nonhomogenous leukoplakia - verrucous, nodular, erythroleukoplakia - gingiva is most common site - multifocal areas
33
what is the histo for PVL
severe dysplasia, larger nuclei to cytoplasm ratio, arranged randomly, no nuclei in keratin, papillary exophytic keratin
34
what is the tx for leukoplaki
- incisional biopsy - guided by histologic dx - hyperkeratosis, mild dysplasia- require follow up - moderate, severe dysplasia, or carcinoma in situ - PVL is difficult to treat, high recurrence - SCC- refer to H and N oncology team - follow up every 3-6 months for PVL
35
what is erythroplakia
- a red patch that cannot be clinically or pathologically diagnoses as any other condition - precancerous lesion - almost all true erythroplakias demonstrate significant dysplasia, carcinoma in site or invasive SCC - related to tobacco and alcohol use
36
what is an erythroleukoplakia
intermixed red and white lesion
37
what are the clinical features and tx of erythroplakia
- most common in middle aged aults - FOM, tongue, soft palate -well demarcated, erythematous patch - soft- velvety texture -tx: guided by histologic dx, dysplasia or carcinoma in situ- excised with clear margins, SCC refer to H&N oncology team
38
what is actinic chelitis
-diffuse, precancerous alteration of lower lip vermilion - excessive UV light - light complexioned individual who sunburn easy
39
what are the clinical features and tx for actinic chelitis
- most common in fair skin individuals - middle age to elderly adults - strong male prediliction 10:1 - blurring of vermillion border of lip and skin - rough scaly areas develop - tx: areas of induration, ulceration or leukoplakia should be biopsied, encourage sun protection
40
what is squamous cell carcinoma
- oral cancer- 2% of all cancer types in the US - most common oral cancer- 90% of oral cancer - multifactorial cause
41
what are the risk factors for squamous cell carcinoma
- extrinsic factors: tobacco, alcohol, UV light - smokers: 3x risk compared to non smokers - tobacco and alcohol: 15x risk - intrinsic factors: systemic states, general malnutrition or iron deficiency anemia, hereditary states. iron deficiency anemia- impaired cell immunity
42
what are the clinical features of squamous cell carcinoma
- most common in older adults over 50 years - male prediliction - most common sites: tongue, lateral and ventral surface: 50% , FOM is another common site - hard palate and dorsal tongue uncommon sites - may be asymptomatic - exophytic (mass forming) - endophytic (ulcerating) - rolled borders, indurated - leukoplakia ( white patch) - erythroplakia (red patch) or erythroleukoplakia
43
what is the treatment for SCC
- consists of radical excision, possible radiation/chemotherapy - tumor size and metastatic spread- best indicators of prognosis - oral and pharyngeal 5 year survival: 64%
44
what is the histo for SCC
- need to see invading inslands of dysplastic sqmoua islands with dark purple cells in between the islands
45
describe verrucous carcinoma
- low grade variant of oral SCC - smokeless tobacco particularly implicated
46
what are the clinical features and tx for verrucous carcinoma
- most common in older adults abve 55 years - male predilection - mandibular vestibule, buccal mucosa, gingiva, tongue, and hard palate - exophytic thick white or pink, papillary surface - patients usually asymptomatic - tx: complete surgical excision, 90% are disease free after 5 years
47
what is the histo for verrucous carcinoma
- broad bulbous rete ridges and deep parakeratin clefts
48
what is HPV positive oropharyngeal SCC
- HPV 16 and 18 implicated - 225% increase from 1988 to 2004 - oropharyngeal infection with HPV 16 causes 14x risk for SCC - HPV implicated in 70% of SCC - HPV viral genes: E6 and E7- prooncogenic
49
does HPV in oral cancer have significant clinical implications
no
50
while HPV ____ oropharyngeal HPV is on the rise, HPV _____ oropharyngeal SCC has declined
- positive, negative
51
why have HPV. positive inclined and HPV negative declined
- increase in oral sexual behavior and decline in tobacco use
52
HPV + carcinoma is strongly associated with:
sexual behavior
53
what are the clinical features ofr HPV positive oropharyngeal SCC
- median age is mid 50's - male 4:1 - increasing incidence in younger patients - oropharyngeal sites: soft palate, base of tongue, tonsillar region, and posterior pharyngeal wall - persistent sore throat, dysphagia, hoarseness - unexplained weight loss - cervical lymphadenopathy - clinically present similarly to oral SCC
54
what is the tx for HPV positive oropharyngeal SCC
- 70% of HPV associated OPSCC patients present with stage III/IV disease - minimally invasive surgical techniques, radiation/chemotherapy - prevention- encourage HPV vaccine - gardasil 9 recommended - protectie against: HPV 6,11,16,18,31,33,45,52,58
55
what is the prognosis for HPV positive oropharyngeal SCC
- HPV positive POSCC has improved outcomes - 3 year survival greater than 82% HPV positive vs 57% HPV negative OPSCC
56
what is basal cell carcinoma
- most common skin cancer - locally invasive, slowly spreading malignancy - arises from basal cell layer of skin - 80% cases arise in head and neck - chronic exposure from UV light
57
what are the clinical features and tx for basal cell carcinoma
- most common in patients younger than 40 - most common in white individuals with fair skin - 2x more common in males - firm, painless papule, slowly enlarges and develops central depression - teleangiectatic blood vessels often present - tx: radical surgery, rare metastasis, 95% cure rate
58
what is the histo for basal cell carcinoma
- hypochromic islands that look like droplets coming off epithelium
59
what is a melanoma
- malignant neoplasm of melanocytic origin - may arise de novo or from a benign entity - UV light major causative factor
60
what are the risk factors for melanoma
- fair complexion - a tendency to sunburn or freckle easily - excessive history of melanoma - family history of melanoma - personal history of dysplastic or congential nevus - personal history of excessive common nevi
61
what are the clinical features of melanoma
- most common in 5-9th decade - most common site for women is lower extremeities - most common site for men is back - ABCDE of melanoma - oral melanoma: MC on palate, maxillary alveolar ridge
62
what is the tx for melanoma
- radical surgical excision - depth of invasion correlates with prognosis - 5 year prognosis for oral melanoma: 10-25% - 5 year prognosis for skin melanoma: thin and confined to skin-90%. regional metastasis- 40-78% distant metastasis- 15-20%
63
what is the ABCDE checklist for melanoma
- A: asymmetry - B: border: uneven or jagged -C: color: more than one color - D: diamter: greater than 6mm - E: evolution: moles that evolve suddenly in size, shape, color, elevation
64
what is the histo for melanoma
islands of malignant melanocytes and aberrant pigmentation and cells look irregular
65

Pathology I (24 decks)

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